In 1999 I gave evidence to an NHS
Government Inquiry - the Griffiths Inquiry - into alleged malpractice
by Professor David Southall who was employed by the North Staffordshire
NHS Trust.

When the Griffiths Report came out I was named as a professional
who had given evidence in relation to the erroneous thinking and
methodology of Munchausen’s Syndrome by Proxy.

The Griffiths Report included a paragraph on the concept of Munchausen’s
Syndrome by Proxy (‘MSBP’) and its potential for errors
of judgement.

This was how I come to be conversant with the evolution of the
MSBP guidelines.

Background

My first letter of concern about the dubious influence of warped
MSBP theorising, dressed up as a beguiling, rare medical disorder,
had been published two years earlier (The Psychologist, 1997).

I feared that this type of thinking, and the methods and draconian
actions which flowed from it, could rapidly work their way through
the system causing untold damage. Unless the flawed thinking was
stopped in its tracks, it was a concern that it could become a basis
for accepted practise.

The core problem in this sector is simply put.

There are many innocent explanations for conditions which might
be labelled as MSBP - later referred to as FII (feigned or induced
illness) and interwoven into thinking about Shaken Baby Syndrome
(SBS). In addition, a score of bona-fide medical disorders are known
to give rise to similar symptoms as well as adverse reactions to
various medical interventions. All in all, MSBP is a diagnosis to
be used sparingly with great care.

The Editor of The Therapist contacted me after reading my letter.
As Professor Meadow had also written a piece in that Journal, she
also asked me to write an article. It came out in 1998. In parallel
with these efforts, which included numerous letters, more articles
and a 1997 New Zealand TV3 Medical Documentary, I made diplomatic
attempts to alert the Civil Service and Ministers to my concerns.

It was in this context that I was asked to give evidence at the
Griffiths Inquiry.

Mr Clark’s Remit: The Griffiths Report

At that time, MSBP was very much a newcomer of uncertain provenance
on the medical scene. But it had already attracted an enthusiastic
following. This fell within the ambit of the North Staffordshire
Inquiry.

At paragraph 12.4 of his report, Professor Griffiths dealt with
concerns arising from the diagnosis and prosecution of parents alleged
to be suffering from MSBP:

“In order to assist in the correct identification of
children who have either had illnesses induced or fabricated by
their carer, the Review recommends that the Department of Health
should convene an Expert and multidisciplinary panel which reviews
methods of identification, including the use of covert video surveillance,
within the framework of the Government’s interagency guidance
for child protection “Working Together to Safeguard Children”
(1999). Guidelines would aid professionals in their identification
of this type of abuse and would suggest good practice in multi-disciplinary
and multi-agency management of such cases”

The Griffiths thinking was clear: the immediate, gateway concern
was the ‘correct identification’ of cases and a ‘review’
of the ‘methods of identification’.

The report’s thrust was the development of proper diagnostic
criteria to counter an inflow of extreme and unfounded diagnoses,
based on equivocal ephemera which were typically indicative of alternative
and innocent explanations.

As subsequent events show, this prudent remit was seized upon as
an opportunity to develop a ‘medical theology’. Under
Mr Clark’s chairmanship, the Griffiths Report was to become
the platform for the reverse assumption and a false premise: that
MSBP was a robust medical construct, commonplace, justifying radical
intervention, which could be confidently inferred from ambivalent
trivia.

In a brief discussion with Professor Griffiths I asked if he thought
I should be on the Panel (which was to become Mr Clark’s Working
Party). He said he did. I then called Lord Hunt’s office and
they asked me to send my CV.

Early Omissions

Some months later, with no sign of a Working Party, and no response
to me personally, I was asked to speak at a conference on this issue
at Durham University.

Prior to the conference, I needed to find figures for allegations
of MBSP for my paper (‘Adding Insult to Injury: False MSBP
and Acquired Autism’). Given the recent profile of MSBP, it
was likely that the figures would have risen considerably. I contacted
the Department of Health as I felt this would surely be one of the
first steps in the recommended review of `methods of identification’.
I was surprised to find that they did not keep figures on MSBP allegations.

When I asked about the Working Party I was told to contact Bruce
Clark. He was in overall charge. When I spoke to his office and
asked if the Working Party had produced such figures, or indeed,
if there even was a Working Party, I heard some laughter in the
background as the person I spoke to asked those in the office.

I was then told to contact Jenny Gray.

Packing the Committee

Jenny Gray’s involvement came as a shock.

I knew that Jenny Gray had previously been in the Social Services
Department in Great Ormond Street.

To my certain knowledge Jenny Gray had assisted the now-disgraced
David Southall into taking at least one child under the false guise
of MSBP. There had been no concerns about the family prior to that
time, and, for the record, I mention that this case is one of many
complaints still going forward to the GMC against David Southall.
The child, with a known serious medical condition, was that night
placed in an experiment and brain-damaged. The case is in the public
domain. From that point in time, it would appear that Jenny Gray
rapidly climbed the promotional ladder in the Department of Health
within the arena of MSBP. She has since been the person to meet
groups such as the National Autistic Society when they raised concerns
with Ministers.

I later discovered that the Working Party convened and overseen
by Bruce Clark:

- did not include a dissenting voice on the MSBP hypothesis

- did include individuals who worked closely with David Southall

To go ahead, this latter group included those who still continue
to work closely with David Southall and Roy Meadow’s MSBP/FII/SBS
agendas – despite public exposure of their illogical and destructive
methodologies so dogmatically presented in the Criminal Courts.

Moving the Goalposts

In due course Mr Clark’s Working Party produced guidelines
which embedded the MSBP thinking into the system. Compounding the
damage, the Royal College of Paediatrics and Child Health produced
their own Guidelines which echoed the DoH Guidelines. The Royal
College was, presumably, influenced by the Government document and
perhaps minded to protect the reputations of both Professors Meadow
and Southall who were paediatricians (the former a former President).

There was no reference in either document to undertaking the preliminary
work which the Para 12.4 recommendations had been all about –
to ensure correct identification.

I submitted a long formal document during the consultation phase
(mentioned in the Sunday Observer, `Ministers knew about Child Harm
Theory’; Jamie Doward, January 2004).

This submission, receipt of which was not acknowledged, began by
arguing that the Civil Service document started from the wrong premise;
the submission went into great detail about the problems inherent
in almost every paragraph.

The underlying problem was that the Clark Guidelines were only
concerned with validating dubious methodologies after a person was
suspected - and not with the crucial preliminary consideration envisaged
by the Griffiths’ Report:

should that person have been suspected in the first place?

Ensuring a correct identification was a crucial preliminary before
Guidelines and policy were built - potentially not just on shifting
sand, but on quicksand.

The proper concern was: What were the theoretical bases to that
suspicion? Were the theories robust? Were there considered alternative
differential diagnoses?

Given the power of rumour and the seriousness of cutting parents
off from their children, and children from their parents, and maybe
even imprisoning parents on suspicion or rumour (The Psychologist
1997) I considered that the standard of proof had to be set very
high.

At the time I interpreted the DoH Guidelines - and I still do -
as a cynical exercise to install the thinking of now-discredited
individuals (whose thinking was already under serious clouds) into
family policy. It was a particular concern that the vehicle for
this doubtful enterprise was misuse of a very serious investigation
– the Griffiths Inquiry – into the liabilities of this
same thinking.

Mr Clark’s Working Party departed from the recommendations
of the Griffiths’ Inquiry.

His Working Party was used not as a forum for serious discussion
into the actualities of assessment but as a manifesto for MSBP.

A Unilateral Venture: Expanding the Department

Only those within the Working Party were privy to its inner dealings.
I am, however, familiar with evidence of Jan Loxley-Blount. She
had initially contacted me after hearing a piece on Woman’s
Hour where I spoke about the dangers in the use of this theory.
Her account of the same events suggests that information regarded
as inconsistent with the MSBP hypothesis was discarded or overlooked
by the Clark Working Party.

I refer to Ms Loxley Blount’s paper, “The Role of Government
Edicts in False Allegations of Child Abuse” for the 2004 UCAFFA
Conference. The paper, extracted below (Footnote 1) makes the corroborative
point that, even at the 11th hour, the Ministers and Civil Servants
with secondary responsibility in this area:

- seem to have remained unaware that there were serious questions
about MSBP

- had not seen the voluminous evidence contradicting the assumptions
of their Chair

The Guidelines finally issued (Working Together to Safeguard Children:
Fabricated and Induced Illness) permitted, and indeed encouraged,
the making of these dangerous diagnoses on almost any grounds; and
recommended rapid referral by medical practitioners when suspicion
arose. These serious interventions were on the basis of a belief-system
mispresented as a robust scientific and medical theory.

The Guidelines also ensured that workers involved after the `referral`
would believe they were acting on a reliable medical diagnosis which
could not be challenged. From then on, alternative explanations
would be ignored, and protestations of innocence warped into forms
of ‘denial’.

Medical practitioners originally involved with the case would assume
that the checks-and-balances would be dealt with afterwards by the
social workers. Everyone involved laboured under the delusion that
someone else would carry out, or had carried out, the necessary
evaluation. As matters have unfolded, it transpires that medical
practitioners could make the initial damning referral, or revise
their previous sensible opinions, merely on the basis of an unqualified
worker spreading a rumour based on this same erroneous thinking.

Social Consequences: The Scale of the Problem

Since the introduction of the Clark guidelines, the warped MSBP
thinking has performed much as one would expect. It has snaked right
through the system.

It has encouraged workers and professionals at all levels to think
in a medieval manner and misconstrue what is in front of them. It
has fostered a misplaced belief that the road to their suspicions
is paved with robust science and indisputable medical evidence.
It has fostered a misplaced belief that they are protecting children.

The anecdotal figure for the number of parents whose children are
wrongfully removed by virtue of the MSBP / FII guidelines is generally
agreed to run well into the thousands.

The costs to the State for the interventions, the Court cases,
and the care of removed children has run into multiple millions.

The modern-day Barons Von Munchausen are Professors Meadow and
Southall and the enablers such as Bruce Clark. It is a well documented
area, save that the concerns which are well-known were ‘paved
over’ by a Working Party supposedly established to investigate
them.

Intellectual Consequences: The Wrong Mindset

Workers are encouraged to act in a punitive manner toward parents,
wrongly believing in the theories now cemented into the system.
Under this dubious mindset, every denial is seen as proof of guilt;
every action, gesture or even facial expression can be ‘morphed’
to provide evidence of bad parenting or deliberate intention to
harm children. Black becomes white.

No effort is made to change these approaches, which can lead to
appalling outcomes for families. Every complaint, and every programme,
article, or wrongly- convicted person freed is misapplied to embed
the thinking more deeply. Unpalatable evidence is reformatted as
proof of the dangerousness of `these plausible people and their
advocates` (The Therapist 1998).

Caught up in the shroud of psycho-analytic mystery is the idea
that child abusers are highly plausible people who look perfectly
normal. When applied without proper checks-and-balances, as it is,
this idea becomes a licence to pursue cases on the grounds of lack
of evidence. To case-workers reared in this belief, the only `way
out` is an admission of abuse.

Practical Consequences: the Aftermath of MSBP

Real illnesses and disorders are missed or ignored; what is seen
misinterpreted as abuse. The MSBP / FII/ SBS assumption is used
as a launching point to either take parents to Court to remove their
children, or to engage them in misdirected “therapeutic exercises”.
Rather than caseworkers becoming more aware of the practical problems
and real needs in relation to children’s early illnesses,
the opposite seems to have happened.

Ordinary parents are routinely accused of causing their children’s
difficulties.

Social services have no real understanding of autism and Asperger’s
Syndrome. During a period in our history when there is an increase
of bona-fide neuro-developmental impairments, children with these
disorders are instead put on the At Risk Register or taken into
‘care’. Once in care, these same children continue to
suffer from the original problems previously considered factitious
and blamed on their parents. Guidelines increasingly encourage social
workers to see autism - and think attachment disorder.

The interpretative change can be clearly seen in changes in descriptions
of children in adoption `magazines` for prospective parents. Children
with these medical conditions or related health conditions can be:

1. Removed from their parents under an official misapprehension

Such children are given to foster and adoptive parents, resulting
in further harm as the children’s health and educational
needs are not met.

In some cases, the foster and adoptive parents are in turn
blamed for the pre-existing conditions which do not go away, despite
removal from parents

2. Used as a ‘stick’ to blame the parents who are allowed
to keep the children

Parents falling into this category live intolerable existences
under a cloud of suspicion, terrified into thinking their children
could be taken, even in the dead of night. They face case conferences
and core-group meetings. These meetings are frequently attended
by people who have no knowledge either of their child or of their
condition, yet who will be encouraged to keep them on the At Risk
Register on the basis of the reports of others, similarly blinded.

Tactics to split the parents are routine.

Fathers are made to suspect their wives and vice versa. Parents
are told that if they continue to support their spouse, they too
represent a danger to their children as they are `colluding` in
the abuse. Many parents have succumbed to extreme pressure. Their
testimony, induced by duress, is then produced as solid proof of
abuse.

Some of these children and some of these parents are seriously
ill, and indeed dying, because of these malpractices (Private Eye
26th April 2005). (Footnote 2)

A Slipshod Experiment in Social Engineering?

The concept of Child Protection could hardly have departed further
from its intended goal.

If the mantra of `the interests of the child come first’
is to have weight, investigations leading to Government Guidelines
and policy should be seriously undertaken.

The Clark MSBP Working Party demonstrates that not only were the
investigations not a serious venture – the investigations
were not undertaken at all.

Footnote 1

“Draft guidelines on the identification of parents and
carers supposedly guilty of inventing or inducing their children’s
illnesses were released in 2001. They read like the gospel according
to Saint Roy and Saint David. Following my initial contact with
Earl Howe and the subsequent meeting between Earl Howe, Nick Lyell,
Charles Pragnell, Lisa Blakemore Brown and me there was a sense
of needing a political focus to bring the question of false allegation
of Child Abuse to the attention of Parliament.

My husband and I then met with Lord Clement Jones who then met
with Earl Howe. These two front bench Health Spokespersons of
the two major opposition parties alighted on the idea of a Lords
Debate on False Accusation of Child Abuse to be opened by Earl
Howe and summed up by Lord Clement Jones. The debate was eventually
set for 17 October 2001 which was very timely as it was a few
weeks before the closing date for evidence and comment concerning
the draft FII guidelines.
In the run up to the Lords debate there was a flurry of activity.
Earl Howe met Lord Hunt of Kings Heath of the Department of Health
who would reply to the debate for the Government. Lord Hunt was
flanked by key civil servants. Earl Howe presented Lord Hunt with
a compelling dossier of case histories and other information questioning
or disproving the hypotheses of Meadow and Southall and suggesting
that the proposed guidelines on FII were entirely inappropriate.

He came away with the impression that this was the first time
that key civil servants had heard anything contrary to the Meadow/Southall
view. Earlier in that same summer I had written to Beverley Hughes
and to Harriet Harman requesting a meeting to discuss MSBP. I
had known and worked with Harriet on the issue of after school
and holiday provision. My letter was ignored until after Earl
Howe’s meeting with Lord Hunt.

Suddenly I was summoned to the Department of Health. I took Lisa
Blakemore Brown and my husband with me. We met with two of the
same civil servants who had flanked Lord Hunt at his meeting with
Earl Howe. They were fascinated by what we were saying and cancelled
their next meeting to spend longer with us. I concentrated on
the role of voluntary organisations whose propaganda leaflets
were causing much confusion by citing as symptoms of supposed
Child Abuse many things which could equally be symptoms of Autism,
Asperger’s Syndrome, ADD/ ADHD, Dyslexia, Dyspraxia, CFS/ME
and a whole host of other childhood illnesses or disabilities.
The civil servants were effusive in their thanks and pressed us
to contribute written comments on the FII guidelines. We submitted
a thick lever arch file of compelling evidence from parents and
professionals, together with conference speeches, academic theses
etc. Other key professionals including Dr Paul Shattock OBE of
Sunderland submitted their separate evidence.

In the 17 October debate, when Lord Hunt replied for the Government
we were all pleasantly surprised. He offered to meet Lady Mar
and Lord Astor. He promised that speeches made in the debate and
documents submitted would be taken into account when the draft
guidelines were reviewed prior to publication. How wrong could
we be?”

Foot Note 2

ASPERGER SYNDROMEAnti-social services

It is hard to envisage more ignorant or unsympathetic treatment
by the “caring professions” than that meted out to
the Storey family of Rayleigh, Essex.

Debbie Storey, 41, has Asperger’s Syndrome (AS), as do
her sons Ben, 16, and Sam, 12. AS is a form of autism where sufferers
often have high IQs but lack social and communication skills.
This can be seen in apparently “odd” behaviour.

Last year Ben and Sam were nearly taken into care because a therapist
who had been visiting the Storey home decided – without
being qualified to do so – that the children were being
psychologically abused. Nothing could have been further from the
truth. But a confidential report prepared for Essex social services
concluded that Mr and Mrs Storey were “consciously or unconsciously
using their children to meet their own needs.” They were
summoned to a child protection conference and the boys were put
on the “at risk” register for emotional abuse and
neglect.

In what was subsequently found to be only one of a series of
failures by the authorities, no input was sought from any expert
on autism to throw more light on the condition of Mrs Storey and
her sons. Lisa Blakemore-Brown, a psychologist and expert on Asperger’s,
was so horrified by what was happening to the family she even
gate-crashed a case conference to act as a family advocate. She
found the intimidation of the family “absolutely unbelievable
and unacceptable”.

After a mammoth battle with Essex county council involving lawyers
and various experts, Ben and Sam Storey were eventually removed
from the “at risk” register last September. But the
year-long ordeal took an enormous toll on everyone, especially
Mrs Storey. In emails she revealed the depth of anxiety and desperation
she felt throughout the period. In March last year, for example,
she wrote: “They are ripping my family to pieces and there
isn’t anyone who can intervene at a higher level and stop
the damage this is doing to the children.

“Ben is really unwell with all the flu symptoms again that
flare up when he is under immense stress….but thanks to
the core group (those monitoring the children) we’re too
afraid to take him to a GP who has blatant disregard for experts
and is totally ignorant to the needs of a family dealing with
autism….This is spiralling out of control and I’m
rapidly going with it.”

But it was not just her mental health that was suffering. According
to Debbie’s mother Rosemary, Debbie had been fatigued and
feeling unwell for some time but was too fearful to go to the
doctor lest this was interpreted as more “attention seeking
behaviour” that could harm her chances of keeping the children.

She had complained of increased back pain in the middle of last
year and in November was referred to the Royal Orthopaedic hospital
for spine and hip investigations. No cause for the pain could
be found. Instead, according to Rosemary, questions were asked
about whether Asperger’s could have affected Debbie’s
perception of pain.

Later in November the pain was so bad it was frequently causing
Debbie to vomit. A GP at her practice prescribed slow-release
morphine to ease the pain, but another GP took her off it. At
one stage she was in such pain she dialled 999 and was taken to
casualty at Southend Hospital. After two painkilling injections
she was sent home. But she was then readmitted to hospital by
her GP when blood tests revealed worryingly low levels of haemoglobin.
Again she was discharged.

It was only in March of this year that, on mother Rosemary’s
suggestion, Debbie was seen by the consultant who was treating
her brother for a rare renal cancer. It turned out that Debbie’s
“perception” of pain was all too horribly real. She
too was diagnosed with rare renal cancer, only hers had spread
to other parts of her body.

While her husband Michael now cares for Ben and Sam, Debbie is
being nursed by her parents and awaiting an operation to remove
a kidney on 4 May.

Because she is so seriously ill, an advocate from Mencap has
written to the respective health authorities, the Southend Hospital
NHS trust and Castle Point Health Trust, to question and complain
about her treatment. But Lisa Blakemore-Brown has no doubt that
the labels attached in ignorance to Debbie and her family over
the years mean she has not received the kind of treatment and
care she needed when she needed it. “What has happened to
Debbie and her family should not be ignored. We have seen over
the last seven years more and more cases of parents being wrongly
blamed and their real needs ignored. In this case a completely
unqualified person set a rumour running that then permeated the
entire health, education and social work systems, blinding the
professionals. This resulted in no support for the children, no
recognition of their condition – and a mother fighting for
her life.”